Help! Healthnet Medicare Advantage not paying on post op glasses OREGON

[GOS_Queen]

Apparently in 2018 Healthnet Medicare Advantage merged with Centene. The payor ID and claims address updated as well as subscriber #'s.

I have had only 2 claims for post op glasses pay in the last 12 months - I keep getting the run around and am getting no where!!!

Is anyone else in Oregon having these issues?

[Chris Ryser]

Vision plans offer a line of coverage you can depend on..............................





Learn more about which Supplemental Coverage works with your plan.
Contact an agent for details.

Vision plans offer a line of coverage you can depend on. Coverage includes a provider network of optometrists, ophthalmologists and opticians. And for those with busy schedules, you can even get glasses in about an hour at the nation's leading optical retailer, LensCrafters*.


source:

https://www.healthnet.com/portal/shopping/content/iwc/shopping/groups/small/supplemental_coverage/index.action

[Pearlvegas]

Thanks for sharing such a piece of useful information. Your this kind of Medicare services are more beneficial for us.

[drk]

In general, nobody anywhere gets Medicare (and I presume private "Medicare") to pay for post-op glasses.

Nobody I know even bothers.

[jpways]

In general, nobody anywhere gets Medicare (and I presume private "Medicare") to pay for post-op glasses.

Nobody I know even bothers.

I get it paid all the time (I just received 2 payments today, one for a PA resident and one for an OH resident). The additional application and application fee are annoying and having to carry the DME bond generally turns people off, but it's possible.
Now I will say from my experience in dealing with Medicare Advantage plans (the ones I have gotten payment from are Highmark MA, UPMC MA, Advantra, Aetna Medicare, and AARP MA) the rules differ from plan to plan as to what extras (if any) they pay for but in general they pay for frame and base lenses. Every once in awhile I get a request to prove medical necessity, which stops after I send in the information (which I really should make a packet of the info I send in). Now as for why this particular MA plan does not pay for post cataract eyeglasses I cannot comment on because I have no experience dealing with either of those companies. All I can say is that if I don't have the proper information in boxes 17, 17b, and 19, every insurance company refuses to pay the claim.

[drk]

Good job.

[Lori]

In general, nobody anywhere gets Medicare (and I presume private "Medicare") to pay for post-op glasses.

Nobody I know even bothers.

Our office bills Medicare Post op glasses all the time. Glasses are considered hardware and are billed through DMERC. Medicare patients are eligible for one pair of lenses and one frame up to an allowance of around 78.00 after each implant. We always get paid. If a patient has given up their Medicare for an HMO, it's a little trickier but we still bill the HMO using Medicare allowances, and if it's coded correctly and with the right diagnosis we usually get paid. The patient is always told that if not, they will receive a bill.

Furthermore, when billing for Medicare PO specs- we must disclose to the patient any overage charges not covered such as AR coating, photochromatic, deluxe frame (V2025) etc.. The overages are outlined on the ABN form and signed by the patient. This form is kept in the patient's records and will be checked during an audit if one should occur.